For humans, suffering is inevitable. We fall ill, loved ones die, others disappoint or even betray us, whether intentionally or not. But on top of this inevitable or necessary suffering, most of us add some amount of unnecessary suffering. We don’t set out consciously to increase our suffering in unnecessary ways; it is an unconscious process, but its effects can range from annoying to debilitating to fatal.

The goal of ISTDP is to help people free themselves from this unconsciously-driven unnecessary suffering. To accomplish this, the therapist serves a role akin to a guide or coach in an exploration of the patient’s innermost thoughts and feelings. Because these parts of people’s inner lives trigger anxiety and pain, people frequently avoid them—often to the point of a total lack of conscious awareness. The ISTDP therapist helps the patient see that the pain and anxiety of facing them is much less than the damage caused by continuing to avoid them.

Because the therapist is such an active participant in the therapy process—and because changing deeply ingrained patterns of thought, feeling, and behavior is so challenging—many avoided aspects of inner life are triggered in the process of therapy. Unlike most other forms of therapy, ISTDP therapists welcomes this as an opportunity to help patients gain insight and mastery over their problematic avoidances. When patients are able to face their reactions to the therapist head-on, it is often a highly productive catalyst in effecting deep change.

ISTDP was developed by Habib Davanloo, a psychiatrist at McGill University in Montreal, starting in the 1960s, and he expanded and refined in over the ensuing decades. Although Davanloo was trained as a psychoanalyst, he rejected many aspects of Freudian orthodoxy—above all the passive role of the analyst. ISTDP retains many aspects of psychoanalytic (or psychodynamic) teaching—especially the importance of unconscious mental processes and conflicts—but it has many points of contact with other forms of therapy, including Cognitive-Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), Gestalt Therapy, and others.